"Sex and the City," "Sex Education," and how we talk about painful vaginas

It’s been 18 years since Season 4 of Sex and the City aired, and yet the spectre of Charlotte’s depressed vagina – a subplot in the second episode of the season – continues to haunt conversations about vulvodynia to this day.

Vulvodynia is a condition linked to chronic pain in the vulva that lasts at least three months and has no known cause. It’s often difficult to have diagnosed, partly because it involves eliminating other diagnoses until you’re left with the conclusion that the cause of your pain is unknown, and therefore you have vulvodynia. And that only happens if the doctor you’re seeing is knowledgeable of the condition, which is unfortunately not always the case.

Despite an estimated 10-20% of women experiencing vulvodynia at some point in their lives, it remains something that too few know about. It doesn’t help that there is exactly one memorable on-screen mention of the condition: yep, that’d be Charlotte’s depressed vagina. And while looking to Hollywood (or New York City) for accurate medical information isn’t exactly wise, it’s nevertheless important to acknowledge that it’s where common conceptions are shaped.

So what is our sole representation of vulvodynia?

Well, there are a total of four scenes about it on "Sex and the City".

It’s a very minor subplot in an episode that is otherwise focused on Carrie’s catwalk debut (you know, the one where she trips and literally gets walked over by Heidi Klum).

The first scene involves Charlotte telling Carrie she needs a new gynaecologist because the one she’s currently seeing has dismissed her ongoing vaginal discomfort as thrush. This isn’t an uncommon experience for anyone who has vulvodynia.

When Charlotte does see a new gynaecologist, she’s quickly diagnosed with vulvodynia – which would be great, if not for the way the rest of the storyline unfolds.

The doctor reassures Charlotte the condition is “mostly just uncomfortable” and tells her “we can get it under control”. A casual way to talk about what can be a debilitating experience for many, sure, but not altogether bad. That is, until Charlotte’s told she’s being given a light antidepressant to treat her vulvodynia, which is an accurate treatment method, but which isn’t given adequate context.

The use of the drug in this instance has nothing to do with mood; it’s for nerve pain. But "Sex and the City" merely uses it as a springboard for a whole lot of jokes about Charlotte and her “depressed” vagina, as well as her treatment plant. At one point, Miranda and Carrie even suggest that Charlotte’s vagina is depressed because she thinks it’s “ugly.”

The whole plot culminates in one more throwaway scene later in the episode, in which Charlotte looks at her vagina in the mirror for the first time and seems to realise it isn’t ugly. Which is not really relevant to the whole vulvodynia thing at all.

And that’s it. That’s the whole plot.

While this episode, over a decade on, has undoubtedly given many people some frame of reference to use when talking about vulval pain, it’s arguably done more damage than good.

The cruel dismissal of Charlotte’s pain by her friends only reinforces the stigma that’s all-too-commonly associated with vaginal and vulval conditions. And the suggestion that it’s an easy fix – explicitly, through the doctor’s statement, and implicitly, in the way the subject is quickly dropped altogether – belies just how difficult it can be to treat, potentially adding to the isolation of those who are suffering with it.

“It’s like my vagina has lockjaw”

From a depressed vagina on "Sex and the City" to one with lockjaw on "Sex Education": it took nearly two decades for vulval/vaginal pain to make a pop culture appearance again, and while at first "Sex Education"’s take doesn’t seem a whole lot better, it does offer some hope.

"Sex Education" is about a teen boy named Otis who takes inspiration from his sex therapist mother and sets up a “clinic” at school, offering advice on all kinds of bodily and sexual issues that he is vastly unqualified to give. In Season 1, he’s approached by Lily, an outsider desperate to lose her virginity but who finds penetration impossible. “It’s like my vagina has lockjaw,” she explains to Otis.

Otis diagnoses her with vaginismus. Where vulvodynia is characterised by chronic pain, discomfort and burning around the vulva, vaginismus is associated with the involuntary tightening and spasms of the vaginal muscles. It’s thought to affect up to 7% of women.

From the symptoms we see depicted, Lily does indeed seem to have vaginismus, and having it identified as such is clearly helpful to her. Less helpful is Otis’ completely incompetent solution: he suggests that her problem is linked to anxiety, and so she needs to confront her fears by...riding a bike down a hill? Of course, it doesn’t work, and if that’s where the show had left it, the whole plot line would be rather troubling.

Thankfully, Season 2 picks up on Lily’s storyline again, this time seeing her not only communicate effectively about her condition with an understanding partner, but also able to engage in pleasurable sexual activity (including some penetration). Crucially, the season also reveals that Lily has not only seen an actual real medical professional about her vaginismus, but she has been given a proper treatment plan, and is using dilators as part of that. And then the show, remarkably, shows the dilators on screen multiple times.

It’s the kind of representation that’s real, and vital. It shows the work Lily has to put in to treat her condition, but it also shows hers is not a helpless or hopeless case. For people already diagnosed, it normalises their pain and helps to undermine their sense of isolation. For those who may be experiencing problems but are yet to be diagnosed, it can open up useful conversations and set them on the path to the right treatment.

Unfortunately, it’s still just one depiction, and while it shows we’ve come a long way since Charlotte’s depressed vagina, the fact that there’s literally no other examples of vulvodynia or vaginismus in pop culture proves we’ve still got far to go.

The more we can talk about painful vaginas and vulvas, the less alone people will feel in their pain – and perhaps even one day, the less pain there will be.